To The Best Of Our Knowledge; Cracking Up

From Wisconsin Public Radio and PRI, Public Radio International, it's to the best of our knowledge, and Jim Fleming. I mean anxiety is ubiquitous. It's not just an existential concern, but a universal and evolutionarily necessary emotion. If we didn't experience anxiety, we'd get hit by cars a lot more than we already do across the street. We need to be able to experience that state of kind of nervous vigilance about threats. It's get a day light, and make a nightmare, untonsent, underverse. Everybody, all around me, shaking hands and saying howdy. I don't think it's

funny no more. Man, they're coming to take me away. Ha ha, they're coming to take me away. Oh, he ha ha, it's the funny farm where life is beautiful all the time. And I'll be happy to see those nice young men in their clean white coats, and they're coming to take me away. Sinol is writing book on psychopaths. I wanted to see if I could turn myself into one. You'll be glad to know it's worn off. War off quite a while ago. You think I'm psycho, don't you remember? I didn't mean to break your cup. You think I'm psycho, don't you remember? You better let them lock me up. Mother, my mother, what is it phrase? She isn't quite herself today. We all go a little mad sometimes. Haven't you? Well, psychopath

up. Today, mental illness and the thin line between the sane and the insane. We'll talk with writer Susanna Cahelen about the mysterious disease that made her insane for a month. Also, writer Daniel Smith talks about anxiety and neurologist Oliver Sacks may make you wish you could hallucinate. But first, if you ever wondered if you might be a psychopath, you'd be in good company. Psychologist Kevin Dutton says some of the most successful people in the world are psychopaths, and they don't eat their dinner guests either. Dutton's the author of The Wisdom of Psychopaths, what saints, spies, and serial killers can teach us about success. He tells Steve Paulson the word psychopath is largely misunderstood. No sooner is the word psychopath out, the images of Ted Bundy, Jeffrey Dahmer, and a whole list of discreditable politicians come kind of siding across

the bad lands of our minds. But, you know, being a psychopath doesn't automatically mean you're a criminal, and it doesn't mean you're a serial killer, either. In fact, a lot of psychopaths aren't even in prison, Steve. They're out there locking other people up. Now, why is that? Well, when psychologists talk about psychopaths, we're talking about a person with a demon, a distinct set of personality characteristics, things like ruthlessness, like fearlessness, charm, manipulation, ability, focus, and extreme coolness under pressure, as well as a lack of empathy and a lack of conscience. Now, notice that I never mentioned violence in amongst that lot, okay? Now, if you happen to have those personality characteristics, and you also happen to be violent and stupid, then to be perfectly honest, your prospects aren't going to be that great. You're going to end up as a low -level criminal, or an enforcer for a criminal gang, or something like that, either way, you're going to wind up in prison pretty quickly. But now, imagine you've got those

kinds of personality characteristics, but you are not naturally violent, and you are intelligent. Now, it's a different story altogether. Now, you're more likely, as the famous Reuters headline once put it, to be more likely to make a killing in the market than anywhere else. I suppose we could then look at lots of people at the top of their professions. I mean, not just the day traders, but they could be lawyers, surgeons, CEOs. It sounds like those qualities that you just described might serve these kinds of people very well. Steve, you've hit the nail right on the head there, mate, actually, and I'll give you some documentary evidence for that. Last year in 2011, I launched the Great British Psychopath Survey. Now, participants were directed onto my website, where they completed the Levenson Self -Report Scale of Psychopathy. It's a standardized psychometric test, which measures psychopathy characteristics within the general population. And what I wanted to find out was what was the most psychopathic profession in the UK, so as well as actually getting their score, feedback on their scores, participants, actually entered their employment details, what kind of

job they did, how much money they owned over the course of a year. And we got over five and a half thousand Respondees to that survey. And when I looked at the analysis, when I looked at the data at the end, the results really were an eye opener. I mean, of course, you had at the top of the tree, the most psychopathic professions were your CEOs, they, in fact, were number one. But I have to say it to your panel number two was media, radio and TV, actually. Journalism was down, and I think about number six or number seven, so there you go. You've got a lot to ask of all. But really interesting was round amount number seven or eight were the clergy. Now that was a real eye opener, but I've spoken to a lot of people since and perhaps we shouldn't be so surprised. The bottom line is that any kind of profession where you've got a power structure, where you've got an organizational hierarchy, when there's the chances of wielding control and power over other people, then you're going to get psychopaths doing very well in that particular kind of milieu. It seems like there's kind of a paradox here because you're saying one of the qualities of psychopaths is they tend to be charmers. They can

win people over partly by the force of their personality, and yet another quality would seem to be a total lack of empathy. And yet if you have people skills, usually you have empathy along with that. You got it. Now one of the really interesting things there, I was a member interviewing a psychopath a few years back, and he said, you know what, you don't need to have color vision in order to know how a traffic light works. You don't need to see the red or the green. All you need to do is know which bits are lit up, and then you can act accordingly. Now what we know about psychopaths is there's two different kinds of empathy, Steve. You've got what's called a cold empathy, and you've got a hot empathy. Now cold empathy is to do with reasoning and rational thought. Hot empathy I describe as the feeling of feeling what another person is feeling. Okay, so psychopaths it's true. Don't have the hot empathy. They don't feel what you're feeling, but they have a cold empathy. They are very, very good at cognitively and dispassionately gauging what you might be feeling. And that allows them to

be able to push the psychological buttons that really kind of get the rest of us going with relative impunity. And that's what makes them very, very good persuaders. Well, it sounds like you're saying then that most of us have some qualities of the psychopath. It's just not to the extreme that the true psychopaths, I mean the killers that we hear about would have. Absolutely right, Steve. Again, you've absolutely hit the no -rotten the head. And now an analogy that I use for this, one of the reasons that I wrote the book in the first place is to debunk the myth that being a psychopath is an all or nothing affair, you're either a psychopath or you're not. Now, those characteristics of the psychopath that I mentioned to you earlier. So we've got charm, persuasiveness, ruthlessness, fearlessness, focus, lack of empathy and conscience. Imagine those characteristics as being the dials on a studio mixing desk, okay? Now, they can be twiddled up and down in various combinations. Now, it doesn't take a rocket scientist to figure out where this one's

heading. If you twiddle all those dials up to max, you overload the setting and you wind up getting 30 years inside. You blow the circuit, okay? However, if you turn some of them up high and some of them down low depending on the circumstances, you become, in other words, as I say a method psychopath, a little bit like a method actor, then you are going to have perhaps the kind of personality combination in a given context to predispose you to success, to give you quite an advantage. So just like height, weight or IQ, all those personality characteristics that make up the psychopathic personality profile, they're all on a continuum, they're all on a kind of a mixing desk slider and we're all on there. Some way between minimum and maximum and it just depends. The combination of them that you have turned up higher and turned down lower any given time. Now, you actually subjected yourself to something called, or at least you call it, a psychopath makeover. Can you tell me about that experience? I was

writing a book on psychopaths, I wanted to see if I could turn myself into one. You'll be glad to know it's worn off. War off quite a while ago. I'm relieved, thanks for telling me. So my friends would wonder about that, but what I did was I have a friend of mine who's a special forces, an ex -special forces sergeant back in the UK. I've measured him and he's pretty high as you would expect. Actually, a lot of special forces guys are pretty high on the psychopathic spectrum. He's pretty ruthless, he's pretty fearless. He's mentally tough, he's very focused, all of those kinds of things. I set up a test of cool in my lab. I wanted to see if I was cooler than my friend. So the way it worked was like this. First of all, we sat down in front of a screen and we were wired up to various electrophysiological measures, heart rate, galvanic skin response EEG stuff like that. And we were watching a very quiet, meditative scene, wired up in these chairs to this equipment. Just to get our baseline measures. And then at an undisclosed moment, that scene changed to a scene of carnage,

pretty nauseating, not just horrific images. And they were really, really bad scenes of dismemberment and really, really, pretty bad stuff. And it was very strange because as we were both waiting for the scene to change, both my physiological readings and those of my special forces friend were both higher, obviously, than our baseline levels. But actually, when all the scene changed and the carnage and the mayhem, and I should add, it was also accompanied by white noise and blaring claxons and sirens. When all that, we were confronted with it. My physiological readings continued to go up, but my friends' readings started to go down. Now that's really spooky. It was almost like in the heat of battle, he thought, this is no big deal. I can handle this. This is nothing. Now then I underwent what you rightly described as a psychopath makeover. Now there's a technique out there called TMS, Transcranial Magnetic Stimulation, which is a way of stimulating, turning up or down various areas of the cerebral cortex, which is the kind of the top layer of the brain, the

newest layer. And that, the cerebral cortex has projections to deeper core brain structures, such as the emotion areas. So we can emulate, we can mimic the brain state of the psychopath by turning various areas of the brain up or down. So using this TMS is Transcranial Magnetic Stimulation, which pulses high frequency electromagnetic pulses to these specially selected areas of the brain. We can turn these areas up or down. So I had my, it was the first time anyone had done it, Steve. And it was very scary. I did feel a difference. We're changed for you. Well, I'll tell you what changed. First of all, in order to find the correct coordinates of the emotion areas of my brain, my colleague actually started stimulating the somato sensory cortex responsible for the movement of the little finger in my right hand. And the spookiest thing of all, possibly was just sitting there, and just suddenly feeling the little finger of my right hand moving uncontrollably, because he was pulsing this electromagnetic field into that area of the brain. Once he'd got those coordinates, he could then kind of map out the important areas of the brain that we were targeting. After about 10 or

so minutes, Steve, the only way I can describe it, mate, it felt like I'd had about half a bottle of wine, or a few shots of electromagnetic jack Daniels. So you basically became desensitized? Desensitized to the kinds of violent images that you'd been looking at? I did indeed. I became very relaxed. I really couldn't care too much about, you know, general everyday concerns. Actually, when I was subjected to the images the second time round, so see if I could be cooler than my friend with a psychopath makeover, it was all filmed. And I'm actually on camera as saying, you know, the guy before me, in other words, me without the psychopath makeover, found these images very disturbing. But this time round, I'm finding it very hard to suppress a smile. And not only that, but all the electrophysiological responses that went along with that corroborated my sentiments, all my readings went down by about two -thirds, compared to what they were before. I still wasn't cooler than my friend, but I certainly was reduced on my

disgust response, on my anxiety response, those kinds of natural physiological responses that I had. And it really did. You did feel different. One final question. You call your book The Wisdom of Psychopaths. Do the rest of us who don't think of ourselves as psychopaths in any particular way? Do we have something to learn from this kind of research you've been talking about of these traits of psychopaths? Yeah, absolutely Steve. Psychopaths have a conglomeration of very positive traits that they use in everyday life. I mean, psychopaths are assertive psychopaths don't procrastinate. Psychopaths focus on the positives of situations they don't take things personally. They don't beat themselves up when things go wrong. They don't overly criticise themselves. And of course, they're very cool under pressure. So these are everyday characteristics that we can use in our lives, not just at work, but also when we're with our friends, when we're with our family. You know, we could all do perhaps with turning a few of those dials up a little bit higher to the right. One example I always give is, imagine if you're at work and you've

been thinking about putting in for a raise. You know, like a lot of people are scared of putting in for a raise, asking their boss for a raise, because they're scared of not getting it. They're scared of what their boss might think of them if they don't get it. They're scared of the consequences. Well, psychopath up. You know, don't focus on the negatives. Focus on the positives. Focus on the reward of getting it. Be confident and go for it. You know, way more likely to get these kinds of things if you're confident, if you're positive, if you focus on the rewards, rather than being negative and a little bit scared of these kinds of situations. Okay, there's a little bit of wisdom to take away psychopath up. I'll remember that. Thanks, Kevin. Not at all. Thanks, David. It's a real pleasure, mate. Kevin Dudden's the author of The Wisdom of Psychopaths. What saints, spies, and serial killers can teach us about success. We spoke with Steve Paulson. So, do you think tapping your inner psychopath could improve your life? Join the conversation on Facebook, Twitter, on our website, ttbook .org. Coming up, a

newly discovered autoimmune disorder nearly destroyed Susanna Cahalin's mind. She tells her story next as we continue our hour on mental illness. I'm Tim Fleming. It's to the best of our knowledge from Wisconsin Public Radio and PRI Public Radio International. Susanna Cahalin was a healthy 24 -year -old, with a loving boyfriend, and a promising career as a journalist at the New York Post in 2009. Then, she started showing

signs of mania, followed by seizures, memory loss, paranoia, psychosis, and near -death catatonia. Cahalin chronicles her experiences in the book Brain on Fire, My Month of Madness. I can't hear their voices anymore. Her skin is so smooth. I stare at the doctor's cheekbones and pretty olive skin. I stare harder, harder, harder still. Her face swirls before me. Strand by strand, her hair turns gray. Wrinkles, first just around her eyes, and then around her mouth and across her cheeks, now line her entire face. Her cheeks sink in, and her teeth turn yellow. Her eyes begin to droop, and her lips lose their shape. The striking young doctor ages right before my eyes. I turn away and look at Stephen, who stares back at me. Stephen stubble morphs from brown into a muted gray. His hair turns white like snow. He looks like his father. Out

of the corner of my eye, I watch the doctor. Now she's growing more radiant with each passing second. All the wrinkles on her face smooth out. Her eyes grow pert and oblong. Her cheeks gain baby fat, and her hair turns a deep chestnut brown. She's 30, 20, 13. I have a gift. I can age people with my mind. This is who I am, and they cannot take this away from me. I am powerful, stronger than I have ever been in my life. Susenica Haling with an excerpt from Brain on Fire, my month of madness. At first, she said she thought her illness might have been caused by a bed bug bite. And then things spiraled out of control. As the disease progressed, I became more and more psychotic and paranoid. And I started losing the ability to control my emotions. I diagnosed myself with bipolar disorder. I had a diagnosis, and I was very relieved to kind of feel I was part of a group, people with bipolar disorder. Did you go to anyone to have that confirmed? I did. I went to a psychiatrist who did

confirm it, I mean, hesitantly. I went and saw her once, but she did give me anti -psychotic medication following one meeting with her, because I was that extreme of a presentation. Wow. And then I gather there was one night with your boyfriend with Stephen, when you had a really truly terrifying experience. Yes, that was the night I had a seizure. And I don't remember any of that time, but he does. So we were watching TV, and I hadn't been able to sleep. I hadn't slept for about three days prior to this. So I had really terrible insomnia. And he heard this kind of grunting coming from me. And he thought I was just really annoyed that I couldn't sleep. So he turned to me and said, you know, are you okay? And I didn't respond. And he saw that my eyes were wide open, but completely unseen. He said, he kind of touched me and said, are you okay? And all of a sudden, my arms shot out in front of me. And I began to seize, and blood and foam came out of my

mouth. It was that kind of that moment, that first seizure, first of many to come, was kind of that moment that marked the line between sanity and insanity. And after that moment, creating memories became a difficult for me. So I don't remember most of the time that happened after that first seizure. One of the terrifying things about this, and one of the realities, I guess, you've had to face, is that that woman suddenly became someone else. You actually don't know her. You only know her by reports from others. Yes, initially the second part of the book, which is my month stay in the hospital, I wrote in third person, because that's how far removed I feel from that person, that other Susanna. Now that night, you were actually lucky to be with Stephen, weren't you? He figured out what was going on, and what turned you on your side, assumed it was a seizure, got you to the hospital. Exactly. Looking back now, I realized that this seizure saved my life, because before so much of this disease presentation had been psychiatric in nature, or behavioral in nature. So you had all these kind of paranoid thoughts, and these bizarre behaviors. But

this was a very physical manifestation of the disease, and not everyone who has a disease has a seizure. So what happened was I ended up in an epilepsy ward, as opposed to a psychiatric ward. So I think the seizure actually really did save my life. So that's good and bad, in a way. On the one hand, you were out of your mind, almost literally, out of your mind. Yes. But you were on a medical ward where perhaps they might look for things other than a psychiatric explanation? Exactly. That's exactly what the case was, because I was at NYU Medical Center, and I was being seen by all these top neurologists and epileptologists and neuropsychiatrist and psychopharmacologist, a combination of the two. I think because I was on this floor where so many doctors were coming through, that was key to getting an early and swift diagnosis. When did things begin to turn around? You had a lot of tests. Was this after you went in having had the seizure? Yes. I had about two MRIs

that came back completely normal, completely clean. And then when I was in the hospital, I got more MRIs. Every single blood test, you can possibly think of reams and reams of tests. Any test you can think of, I pretty much got it at the hospital. And it was all coming back negative. On paper, I was normal, but I was sliding further and further away. So when I first got to the hospital, I was acutely psychotic, and actively hallucinating. And as my state progressed, I started to become catatonic. And I could no longer really communicate. And I would stare off and do these kind of strange mouth -lipped smacking movements and these abnormal body movements. I'd leave my arms out at 90 degree, almost like a T -rex in a way or a mummy in another ways. I would leave my hands out these kind of abnormal movements. So that was kind of sliding further and further into a catatonic state that would probably progress into a comatose state. Again, you described this as behavior, but you actually don't remember it. You've seen it though, haven't you? There was some video of you when you were in the hospital. Yes, I was on the

epilepsy floor, and they monitored their patients with video cameras. For obvious reasons, yeah. Exactly, because they want to be able to see the seizure. So I have actual videos in my possession. I don't watch them very often of me in the hospital. And one of the videos that I have is me actively hallucinating. I'm shouting at the camera. I'm on the news. I'm on the news. And I actually remember being inside her. And I say her, because again, I feel so divorced from that person. And I remember seeing myself on the top of the hour news and believing that my father had killed my stepmother. That was what I believed. That was kind of a elaborate hallucination that I had. That my father had killed my stepmother. There are media trucks outside waiting to interview me. Well, the good news is that you are here to talk to us about this, which means you came through it. I guess we have to go back to that point and figure out what happened. The doctors were saying no hope, basically. Right. But something happened. Someone, I guess, happened. My own version of Dr.

House. My mom named him Dr. House. His name is Dr. Sue Hell in the jar. And he's a neurologist, epileptologist. He's an amazing man at NYU. We did several things that were very unique. But one of the things he did was he took a very detailed history. So he took all of the presentations of the disease, the bed bugs. He took into account the numbness that I had. These early paranoid thoughts. Then I had kind of heart rate instability. He took all of these various components. And he was able to kind of put it together into a whole picture. And it was during that time that he kind of had the stroke of insight that he said, I'm going to ask her to draw a clock, which is typically a test given to Alzheimer's patients. Now, I was 24 at the time when this happened. So this is not a typical test you'd give to a 24 -year -old. But he thought, I'm going to try. And so he asked me to draw a clock. Just a circle with the numbers on it. I actually drew the circle fairly well, which I learned later as an over -learned practice. So even people with severe brain trauma can still draw a circle.

So I drew a circle, and I drew in all the numbers, one through 12 on the right -hand side, and completely left the left -hand side blank. And that proved to him that this was a neurological disease, not a psychiatric disease, because that was still something that was being explored. This is where the title of your book comes from. He said your... My brain is on fire. He actually took my parents out of the room that we were in, and he didn't say in front of me, but he said to them, her brain is on fire. He knew that this clock revealed that the right -hand side of my brain was likely inflamed. So when my parents heard your daughter's brain is on fire, they were relieved. You wouldn't think that your brain is on fire would be relieved, but they were actually relieved by that. Well, I suppose that's the beginning of the point at which you can begin to treat it medically rather than with a less certain psychiatric care. But how certain was it? What can you do at that point? Your brain is on fire? So at that point, they didn't know the answer yet, so he did a brain biopsy. To check,

indeed, if it was inflammation, because basically they wanted to start treating new steroids to kind of reduce this inflammation that they believe was in my brain. But if you started the steroids and then tested for it, it might not show up. So he said, okay, we have to do a brain biopsy, and we need to do it in the next two days. So they did a brain biopsy, confirmed the inflammation. There basically was still question, what is causing this inflammation? Because inflammation can be caused by a host of things. And he had read about a newly discovered disease. It was discovered in 2007 called anti -NMDA receptor autoimmune encephalitis. And during that time, there was only one place in the world that tested for it. And that was at University of Pennsylvania. And he sent my spinal fluid to University of Pennsylvania. And that's how it was ultimately diagnosed. And they confirmed it. And you were one of the very first people to be counted as having this, right? I was a 217th person to be diagnosed with this. In the world? Yes, yes. And not the 217th person

to have it distinction there. 217th person to be diagnosed with it. So what did they do? The steroids took care of it? Yes, well, it was a combination of steroids, which reduces inflammation, kind of quells the immune system as well. And immune therapies that take out these kind of harmful antibodies that are kind of the bad guys in the illness. Basically, your body creates antibodies that target these certain receptors in the brain. And that's kind of the key to the illness. So they kind of strip your body of these bad antibodies and replace them with new, so it's immune therapies. So fairly simple. Tell me, how has this changed the way you think about mental illness? Significantly. I can say it with all certainty that during the height of this illness, when I could age people with my mind, there was really no difference between me and someone who is diagnosed with schizophrenia, the only difference was that I was cured. That's the only difference. So of course, you have to look at that

differently. You just have to. Though it's called the psychiatric illness, it's also neurological in nature. We just don't know the causes yet. And it makes you hope that one day, you know, this black box that is the brain, this kind of final frontier, that hopefully one day we will get closer to understanding what makes it work and what makes it malfunction and get closer to understanding what the causes are of these psychiatric disorders. Susanna Cahalin is the author of Brain on Fire, My Month of Madness. So you know what it's like to feel a little anxious, right? I mean, most of us do. But anxiety can also be crippling. It can make an ordinary choice, like window or eye or ketchup or barbecue sauce. I feel like an issue of life or death. Writer Daniel Smith talks with Anne Strangehamps about his new memoir called Monkey Mind.

Anxiety compels a person to think, but it is the type of thinking that gives thinking a bad name. Solipsistic, self -aviscerating, unremitting, vicious. My walks to therapy, for example, were spent outlining with great logical precision, the manner in which my state of mind would lead me to complete existential ruin. A typical line of thought went something like this. I am anxious. The anxiety makes it impossible to concentrate. Because it is impossible to concentrate, I will make an unforgivable mistake at work. Because I will make an unforgivable mistake at work, I will be fired. Because I will be fired, I will not be able to pay my rent. Because I will not be able to pay my rent, I will be forced to have sex for money in an alley behind Fenway Park. Because I will be forced to have sex for money in an alley behind Fenway Park, I will contract HIV. Because I will contract HIV, I will develop full -blown AIDS. Because I will develop full -blown AIDS, I will die disgraced and alone. From free -form anxiety to death by prostitution in eight short steps. Most weeks, I found that I could kill myself off before I had crossed the bridge into

Charlestown. This gave me half a mile to fully experience the ignominy of my downfall. To see my mother wailing like a Sicilian peasant over my lime -complexed corpse. To see the rabbi eulogizing my unfulfilled promise. To hear the thump of dirt on unfinished pine. To accompany my two brothers as they rush home from grave side. To pull the plastic wrap off the cold cotton platters and switch on the coffee urn. Meanwhile, mounting the hill to the clinic and your horizontal against the angle of a scent. I would do my best to weep for cathartic purposes. These were pathetic attempts at weeping. The bleeding cries of someone who has wept himself dry like an ape laughing. Sweaty with strain and agitation. I would try to manufacture bonafide tears and always, always, I would fail. By that time I arrived at the clinic, I was typically so demoralized I could barely stand. I was 23 years old and I looked like Nixon resigning the presidency. Daniel, that sounds awful. It wasn't good. It wasn't pleasant. When

did you discover that the anxiety you experienced might be significantly worse than what the average person experiences? It was when I was 16. The book begins with this walk to therapy that I'm narrating in what I've just read. But that's just a prelude. The real narrative of the anxiety begins when I'm 16. And when I lost my virginity in a way that a lot of young boys, a lot of boys of 16, might find glorious and wonderful. But which I found disturbing and this was to two older women at the same time. Two at the same time. Two at the same time. And you'd think this is the great dream of a 16 -year -old boy. I had been seduced by an older woman. And when I say older, I was 16. They were probably in their earlier mid -20s. And I had accepted. There was nothing forced about it except that it felt as if I had forced myself somehow. And in the wake of this, for whatever reason, the anxiety that had been within me as a child and that had led me to have little phobias and little ticks, but that had passed, that had come and gone and come and gone, really flourished within me. And the anxiety

took on a kind of totalizing aspect so that every day was just a living nightmare, a living hell. In fact, my waking state was bad, but so was my sleeping state, because anxiety is completely unremitting and just vicious and continues 24 hours a day. That, when I was 16, was when anxiety really became what I knew to be a problem before that it was just, like I said, it came and it went. You had the good fortune to have a psychotherapist for a mother. How did she react? Well, the good fortune, yes, and that she's educated about it. But the bad fortune in that, like most therapists, she went into the practice because she had personal experience with the problem. She eventually became an expert in. So I could both blame my mother somehow in genetic terms and behavioral terms for being at the beginning of my anxiety, the progenitor of it. But I was lucky in that she knew what she was looking at. I'm just thinking about how difficult this must have been for your mother. I mean, did you come home from that experience with

the two women and tell your mother all about it? I told her about it immediately. It was humiliating. I had gone away upstate to see a concert and there was a woman I knew who seduced me and who, when picked up another woman. And we had this night of the battery and 24 hours or so later I returned to Long Island and walked into my childhood home and there was my mother on her bed folding laundry. And I collapsed. I just imploded and I told her everything that had happened and wept and she said, you were raped. You were statutory raped. And she was so angry. She wanted to hurt these women. She wanted to arrest these women. And that turned out to be almost worse than the anxiety itself, which was the shame of knowing that a day or two after losing my virginity I told my mother about it had cried. It was awful. It was so, so shame. It sounds so difficult. I'm very sad. It's a very sad story. But I feel much better now. You make the point that everybody experiences anxiety just not to the degree to which

some people do. What's the divide in line do you think between ordinary kind of existential anxiety and pathological anxiety like what you're talking about? It's hard to say. I'm not a diagnostician. I'm not a theoretician. A lot of time has been spent trying to figure out in mental disorders where the line is. And usually it's a very practical one, which is when it goes on for a while and starts interfering with daily life. I mean, anxiety is ubiquitous. It's not just an existential concern, but a universal and evolutionarily necessary emotion. If we didn't experience anxiety, we'd get hit by cars a lot more than we already do while crossing the street. We need to be able to experience that state of kind of nervous vigilance about threats. But across the line, I know when a cross the line going across the line for me was when it became persistent and seemingly inextinguishable on a daily basis. And when it interfered with my ability to have relationships, I think that more and more these days, the more I go

around and talk about anxiety and think about it and correspond with people about it, the particular hell of anxiety, of chronic, of acute anxiety, disordered mind. For me is when you could no longer love another person because you're so consumed with yourself and with your own thoughts. When you could no longer see anything outside of yourself. That's when, to me, anxiety becomes truly a problem when it interferes with normal human interplay, with relationships. But again, I'm not a doctor. I'm just a neurotic who writes. That happened in your own life, right, with your girlfriend, Joanna, who you later married. But that relationship, you sort of destroyed it the first time around. I did destroy it the first time around. We were living together in Boston. And my anxiety was so bad that I both wanted her and very much did not want her. When you're anxious, you're desperate. You see threats all around you. And in your desperation, you look for the sources of your anxiety. Of course, the sources are your thinking. But you look for external sources. And often you look to your loved ones.

And I thought, I'm anxious because Joanna is around me. I'm anxious because I'm not happy in this relationship. I'm anxious because I am embarrassed and ashamed about being anxious and having this woman who I care about, who I want to see me as a strong person, seeing me as weak and quavering and miserable. So I pushed her away. But at the same time, when you're anxious, you want comfort. You want to lay your head in somebody's lap and have them stroke your hair and tell you everything is going to be all right. So a certain pattern emerges that you can see in the love lives of historical figures who really suffered from anxiety. People like William James or Franz Kafka or Sorn Kirchegard, the really great intellectual neurotics. They fall in love with someone and they proceed to push them away and pull them back in this awful sort of tango, this awful dance until the object of their affection is just exhausted and can't go on anymore. And that's what I did. You're right about the worst moment, the exhausted moment for Joanna. I guess happened in Venice. Happened in Venice in a beautiful pension

overlooking the Grand Canal when she noted that I was no longer saying that I love her. Because anxiety, of course, breeds like lice, breeds doubt, and you can't be sure of anything. And she said, you haven't said that you loved me in so long. I said, I'm not sure that I do. And she began to throw things at me rightfully, luckily, the only thing at hand were rolls of toilet paper. So I escaped pretty much unscathed physically, emotionally I felt awful because it wasn't that I didn't love her. It was that anxiety at that level makes a person incapable of love. I really believe this. Anxiety is so self -consuming, locks you so much into your own thoughts and your own mind that you just can't. You just can't love another person. And at the same time, you know that you can't and you grieve for that. You're aware of your shortcomings as you're experiencing them and hurting other people and it's just awful. And shortly thereafter, she dumped me and was right to do so. Though the story has a happy ending and clearly Joanna is a formidable woman because she

eventually took you back and you're married. It was a few years later when we were apart and didn't talk very much and in that time, I learned some skills. I learned for the first time that I could mitigate my anxiety on my own. I could learn how to recognize the thoughts that were causing me anxiety and how to question those thoughts. I learned a little bit of mindfulness and I learned how because of that mindfulness to wall off my anxiety from the people I love. So that when I experienced anxiety, I no longer said to myself, I am anxious. It must be because of the people around me. I was smart enough and experienced enough by then to be able to say to myself, I am anxious. The anxiety is within me. It is because of what I'm saying to myself. It is a habit. A habit of thinking, a habit of feeling. It is not because I'm around this person. So I built a kind of firewall between my anxiety and the objects of my love. Objects being a terrible way of saying it in regard to the people that I loved and the people that I wanted to actively love. So by then I had learned a few things.

I was still anxious but I just knew a little bit better. I was wiser. Daniel Smith is the author of Monkey Mind, a memoir of anxiety. He spoke with N. Strange Shamps. If you have questions or comments about the program, we really would love to hear from you. You can get in touch with us through Facebook or Twitter or my favorite, our website, TTbook .org. Coming up, Dr. Oliver Sachs on hallucinations as we conclude our our on mental illness. I'm Jim Fleming. It's the best of our knowledge from Wisconsin Public Radio and PRI Public Radio International. Do you think you have to be crazy to see or hear

something that's not there? Illucinations can be the result of mental disease but they can also be caused by injuries in toxication. Or even just falling asleep. N. Oliver Sachs new book hallucinations explores his patients and his own experience of seeing things. Sachs tells Steve Paulson how he defines a hallucination. The old term apparition I think gives a sense of the sudden appearance of a person or an object in front of one in the outside world coming without one's consent, without one willing it and in a way which is extremely different from imagination. With imagination you build up an image, you know that you're the one who is imagining where a hallucination seems to come from outside or from nowhere and it's suddenly bursts into your consciousness whether it's a hallucination of a sight or sound or smell and hallucinations are often very much more detailed

than images and they resemble perceptions. Can you give me some sense of the range, the variety of hallucinations? Yes, there may be very simple ones like blobs of colour or geometrical patterns. There may be more complex ones like seeing people or faces or animals or landscapes. There may be even more complex ones with a mystical or religious component and sort of everything in between. You are a neurologist so you have a professional interest in these matters but my sense is that the whole business of hallucinations is of great personal interest to you as well because you've had some intense experiences of your own. What kinds of hallucinations have you had? Probably the first I had and which I continue to have occasionally are attacks of migraine or visual migraine but here the hallucinations are very simple, repetitive sort in which you tend to see a

brilliant zigzag, scintillating crescent in the visual field and often patterns of lattices or other geometrical patterns. In the 1960s when I was in California and during my neurology residency I had some experience of various drugs. Which you write about in some detail and I have to say it's quite fascinating to read about your experiences with hallucinogens when did this start? It started in 1963 and it really ended in 1967. I tried a range of substances then, partly out of curiosity, partly recreationally because I wanted pleasure. I think partly in the hope of kickstarting some sort of change in myself because I felt that my imagination and intellectual energy was not good. I felt that it had been good when I was a youngster when I had a

passion for chemistry and I knew all sorts of intellectual and other incandescence as them and I wanted some incandescence back. So you tried LSD, mescaline and other things as well? And emphetamine and opioids and a strange drug usually used for treating Parkinson's disease called Artein, except I took 20 times the dose which a Parkinsonian patient would take. So you are serious about this and in fact you write that you often took these drugs weekly sometimes even more than that. I would tend to stick to weekends, I didn't want to be stoned at work, but I think I was always alone and I think I often took large doses and I think I was lucky to survive and I do not recommend such behavior to anyone else. Cafe Hut Taken. So what kinds of experiences did you have? Well, with things like cannabis

and LSD and mescaline and morning glory seeds, I had the usual, the often described, heightening of visual perception and a sense often enough of a great beauty and sometimes a mystical or luminous beauty of everything around me. The sort of thing which Aldous Haxley describes so well in his books, but there were some other sorts of hallucination as well. When I took a large dose of morphine which I especially do not recommend, I had a very elaborate hallucination of witnessing a battle. I saw thousands of soldiers drawn up for contest and silk contents and I realized, quote unquote, that I was seeing Aging Core, the Battle of Aging Core in 1415. I completely lost the sense that I was lying on my bed stoned, I somehow seemed to felt like a

historian seeing Aging Core from a celestial viewpoint. So you felt like you were there, not on the battlefield, but you felt like you had lost your sense of being in your own place and I mean you had been transported to Aging Core? Yeah, I was transported to an aerial viewpoint above Aging Core. Then the experience faded, I thought it had only lasted a few minutes, but it turned out that it had lasted 13 hours. And this frightened me, I realized how one could get into an opium stupa for days at a time and I never took morphine again. But I'm glad I took it once, so I knew what it would be like. How do you explain those visions, I mean that sort of conjuring up the image of watching over the Battle of Aging Core? Well, I think this was in my mind somewhat, because I had just been reading Frasal's Chronicles, the Chronicles by this French medieval historian, I'd also been reading Henry V. And so I think this was the realm from which my

hallucination was constructed, but this was not ordinary imagination. It was absolutely real and I think in this sort of hallucination you find that the sensory parts of the brain and the emotional parts of the brain, the visual system and whatever are being highly stimulated as they would be if one were actually observing the scene. Of course, it seems to me that the great mystery is why you would come up with the particular visions that you had. I mean, it's one thing to take the drug and even if you've been reading about this particular period in history, it still begs the question, why those images, why did they get conjured up in your mind? I don't know if that's one can always give an explanation, there's a particular form of hallucination which I talk about a lot, in fact at the very beginning of the book in which people with impaired vision or blindness get visual hallucinations. These were originally described in the 18th

century by a nationalist called Charles Bonnet, his grandfather had these visions, his grandfather dictated a very detailed account of them. And when the grandfather's book was lost for 150 years but it was found and published at the beginning of the 20th century and psychiatrists were fascinated and they thought this would be like dreams and they might be able to make detailed interpretations of the hallucinations, see them as a royal road to the unconscious. But this didn't work and it tends not to work with most hallucinations, although it may work in relation to schizophrenic hallucinations which are intimately tied to all the fears and hopes and thoughts and complexes of the person. But I don't really talk about those in my book, I think they need a separate book. You said that one of the reasons why you

tried hallucinogens over this period of several years is you wanted to experience the numinous, the transcendent. Do you feel like you had those experiences? Yes and no, I'd been thinking about Indigo and the way in which no two people agree as to what Indigo looked like. I made a sort of chemical launch pad with amphetamine and acid and cannabis and said, I want to see Indigo. So now, suddenly as if thrown by a paintbrush, this trembling blob of luminous, numinous Indigo appeared on the wall. Amongst other things I thought to myself, this is the colour of heaven. This is the colour which jottled try to get when getting heaven. Now I'm an old Jewish atheist and at the time I was a young Jewish atheist, I have no belief in heaven or anything else supernatural or paranormal. But the feeling was there and it was a wonderful feeling. You also write about one auditory hallucination that you had that you say may have saved your life. You were climbing a mountain in Norway. Can you

explain what happened? Yeah, well I had a nasty accident and tore off the great muscle mass from the front of the thigh on one leg and this was more disabling than a broken leg. I was alone, no one knew where I was. I improvised a sort of splint and started to push myself down the mountain. There was one point where I got very exhausted and thought I would like to sleep a little bit. And a rather clear voice said that would be fatal and get up, get going, find a pace you can keep up and do it. And this clear, commanding, incisive, almost emotionless voice was something which I felt I had to obey and which I think in a sense saved my life. When you say a voice it's something you heard, I mean it was a voice. It was an auditory experience. It was sensuous as if

someone outside had spoken to me, had shouted it in my ear. Whereas, of course, I realized it was a hallucination but it was a very beneficent hallucination. Neurologist Oliver Sachs is the author of hallucinations, he spoke with Steve Paulson. It's to the best of our knowledge. I'm Jim Fleming. You can stream to the best of our knowledge on our website at ttbook .org where you will also find a link to the weekly podcast. You can buy a copy of the program by calling a radio store at 1 -800 -747 -7444. Ask for the program cracking up. To the best of our knowledge is produced at Wisconsin Public Radio. This hour was produced by Doug Gordon. With help from Anne Strange Shamps, Charles Monroe Cain, Sarah Nyx, and Veronica Rickert. Special thanks to special guest engineer Joe Hartke. Our executive producer is Steve

Paulson. Our technical director is Carillo Owen.